WEBVTT

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JUDY WOODRUFF: We continue
with our series on
universal health care.

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As the United States struggles
with the most expensive health
care system in the world,

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some have started
looking to Australia.

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William Brangham and producer
Jason Kane report on how that
nation has achieved universal

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coverage at a lower cost.

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Their story was filmed
before the pandemic began.

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WOMAN: Hello.

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(LAUGHTER)

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WILLIAM BRANGHAM: Don't be
fooled by this happy scene.
This is a family divided.

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OK, it's not quite that serious,
but the division is stark when
it comes to, of all things,

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health insurance. On one side,
Felofani Elisara and her husband
Paul Dunn rely on Australia's

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public health care system. It's
known as Medicare. It's paid
for by taxes, and it's available

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to all Australians and
permanent residents.

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That public system has gotten
them through some pretty
traumatic stuff, IVF treatment

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and a hysterectomy for
Felofani, and, for Paul, brain
surgery to remove a malignant

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tumor.

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At first, they panicked
over what they feared
would be a huge price tag.

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PAUL DUNN, Australia: I was
really scared. I was like, what
am I going to do? Do I need

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to start a GoFundMe? Which
my friends did for me and
my family did for me anyway.

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WILLIAM BRANGHAM: But then you
found out that the public system
was going to cover a majority

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of that?

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PAUL DUNN: A majority
of that, yes.

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FELOFANI ELISARA, Australia:
Well, it covered all of it.

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PAUL DUNN: It covered
all of it, actually.

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WILLIAM BRANGHAM: On the other
side:, Paul's parents, Carole
and Ross, are evangelists

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of the private sort.

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They skip over the public
system and buy their own private
insurance coverage. About half

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the country does this. Carole
recently had her knee replaced
and said she got great care

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and terrific perks.

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She says, if she'd been in
the public system, she'd be
in agony, on a waiting list.

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WOMAN: Well, I'd be
crippled, really, in one leg.

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WILLIAM BRANGHAM: This hybrid
system, with the public
Medicare system as a base, but

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then layered with private
insurance on top, is by design.

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They're meant to work together,
with the private system taking
pressure off the busier public

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one. This unique setup meets
two basic values, says health
economist Rosalie Viney.

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ROSALIE VINEY, University of
Technology Sydney: Just as one
of the tenets of Australians'

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beliefs is that they should
have access to public care,
there's also an element that

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choice is part of what a lot
of Australians seem to value.

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WILLIAM BRANGHAM: Help me
understand. If you have a system
where any person, any Australian

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can go and get free care from
their G.P. or at a public
hospital, what is the rationale

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for private insurance?

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Why would I, as an Australian,
ever want to pay extra,
if I can get it for free?

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ROSALIE VINEY: So, some of it
is about access to elective
care at the time when they want

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it. Some of it is about access
to the amenities that a private
hospital might offer. Some

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of it...

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WILLIAM BRANGHAM:
Amenities like?

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ROSALIE VINEY: Private room,
better food, those sorts of
things. You have a choice of

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menu. Some of it is about
choice of your own doctor.

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But some of it is actually about
getting quicker access. So,
waiting lists can be long. And

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particularly for elective
surgery, waiting lists in the
public system tend to be long.

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SARAH KOZICKI, Nurse
in Training: The whole
sense of waiting for me,
like, with endometriosis,

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you could be in bed, like,
chronic pain. So, that could
mean a year without working, two

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years without working.
And it's just -- that's
not feasible either.

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WILLIAM BRANGHAM: A private
health plan makes sense for
Sarah Kozicki. She's training to

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become a nurse, and every couple
of years, she needs a costly
surgery for endometriosis,

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which is a painful disorder
involving the uterus.

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SARAH KOZICKI: So, for that, I
choose to have private health
insurance, that I can go and

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have surgery when I need to
have surgery. I can do it in
a private hospital, or do it

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in a public hospital as a
private patient, and I get
to choose my specialist.

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WILLIAM BRANGHAM: The outcomes
for both systems have been quite
good. Australians live longer

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than Americans, they're
healthier and they see
their doctors more.

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They don't die of preventable
diseases nearly as often as we
do. And they get these results

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for less money, spending about
half what we do per person.

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Costs are kept low partially
because the government
sets prices for drugs,
treatments and other

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expenses. But there's one major
problem. Increasing numbers of
Australians are choosing not to

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buy private insurance,
people like Emily Maguire.
She's a teacher, she's
healthy, and she says

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the rising cost of living
makes it hard to justify
paying for a private plan.

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EMILY MAGUIRE, Teacher: And,
like, the public health system
is so great. Like, they do a

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great job.

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So, I'm just like, no, I think
I will trust them. And if I
need something, then I will

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pay for it myself. I'm not
too worried. It's a little bit
about, I think, my values as

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well. Like, I don't want to be
paying for something that I'm
not really getting anything

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from, if you know what I mean.

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WILLIAM BRANGHAM: An estimated
64,000 Australians dropped their
private health insurance in

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2018, and this creates
what's called a death
spiral for the system.

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Younger people, who tend to be
healthier, have been leaving
the private market, while

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older people, who tend to be
sicker, have been joining it.

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Rosalie Viney says that cycle
then perpetuates itself.

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ROSALIE VINEY: Private insurance
holders tend to be those who
are more likely to use private

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insurance, and so we see
premiums start to creep up,
associated with use of the care.

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WILLIAM BRANGHAM: Remember,
the private system is meant to
relieve pressure on the public

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one. So, now the government
is spending over $4 billion a
year in subsidies to encourage

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people to buy private care.
And that cost keeps going up.

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JANINE MOHAMED, CEO, Lowitja
Institute: So, what would be
better is if we actually took

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a reinvestment of those private
health care dollars, and put
it into our primary health

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care system.

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WILLIAM BRANGHAM: Janine Mohamed
has a very different idea of
where those billions ought

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to go. She runs the
Lowitja Institute, a
research organization that
advocates for better health

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care for Australia's Aboriginal
and Torres Strait Islander
populations, people who've

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suffered decades of
racism and discrimination.

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On average, people from
indigenous groups, like Kylie
Battese, suffer higher rates

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of chronic diseases than their
peers. Mohamed says they die
11 years earlier, on average,

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than non-indigenous Australians

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JANINE MOHAMED: It just
seems ridiculous that
those funds can't be
redirected to Aboriginal,

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Torres Strait Islander health,
when we know that we have the
poorest health outcomes in

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Australia.

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So, for us, it's, you
know, giving the most
privileged more funding.

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WILLIAM BRANGHAM: Dr. Ashish
Jha, dean of the Brown School of
Public Health and a collaborator

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with us on this series,
says, yes, there are
significant problems here.

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But every nation's health system
is a work in progress, and
Australia has made important

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strides that the U.S. hasn't.

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DR. ASHISH JHA, Director,
Harvard Global Health Institute:
When we look across the world,

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we see lots of different
systems that seem to work. They
get universal coverage, good

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outcomes, reasonable costs.

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They don't all look like each
other. And there's a lot we can
learn from Australia, from the

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U.K., from Switzerland, all
of which have very different
systems from each other. But

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each of them can teach us
specific things about how we
can improve coverage and lower

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costs and improve outcomes
for our own country.

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That's the key here, is to learn
those lessons without worrying
about importing any of these

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systems wholesale and
trying to transplant them
into the United States.

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WILLIAM BRANGHAM: The members
of the Dunn family have given
up trying to convince each

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other that their health
care choices are best.

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WOMAN: Cheers, guys.

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MAN: Cheers.

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WILLIAM BRANGHAM: They're
OK with the division.

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WOMAN: And I was going to
say, vive la difference.

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WOMAN: Vive la difference!

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WILLIAM BRANGHAM: For the "PBS
NewsHour," I'm William Brangham
outside Sydney, Australia.